21D2157615 CLIA NUMBER - WALMART PHARMACY 10-2931

Laboratory Demographics

  • CLIA Code: 21D2157615
  • Facility Name: WALMART PHARMACY 10-2931
  • Facility Address: 409 N FRUITLAND BOULEVARD
    FRUITLAND, MD
    ZIP 21826
  • Facility Phone: 410 341-6208
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PRAMOD K. PARSHABOINA
  • NPI Number: 1649298167
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2157615
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2931
Street 409 N FRUITLAND BOULEVARD
City FRUITLAND
State MD
ZIP 21826
Phone 410 341-6208
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/8/2024
Certificate Expiration Date 11/7/2026
Facility Type Pharmacy
Lab Director PRAMOD K. PARSHABOINA

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This page was last updated on: 6/4/2025